Quelling research excellence in residency programs

Canadian residency programs currently do not provide sufficient latitude for residents with research skills to pursue scientific questions. In contrast, US programs apply different training tracks that encourage research and provide certain advantages to the graduate.

The Canadian Institutes of Health Research funds about 20 to 30 students per year to pursue combined MD and PhD degrees. A stipend is provided during both medical and graduate school. Dual training is intended to cultivate skill in identifying promising therapeutics emerging from the morass of a growing literature.

Here in Canada, graduate residency training commences after 8 or more years of dual training in MD/PhD programs. Typically, we pursue a research project in the basic sciences, exploring molecular mechanisms of disease in graduate school after 2 years of pre-clerkship, then return to the MD program for clerkship.

The first 2 years of residency are clearly essential for clinical competency. Being underpaid and overworked as residents is held as a rite of passage to, one hopes, better days. But for MD/PhD graduates, another issue arises: How best to maximize our research potential? In spite of being trained to the gills, there is little hope of translating anything until late in our fellowships. This is 5 to 6 years since our last research contribution and makes our previous work an anachronism in the fast-paced world of molecular medicine.

In comparison, US MD/PhD programs offer residency tracks called “research pathways.” The American Board of Internal Medicine (ABIM) allows MD/PhD residents to re-enter the lab in the third year and couple their specialty of choice with their research interest. So while the core training is fast-tracked (2 years v. 3), the specialty training is long-tracked (4 v. 2). The assumption is that 2 years of internal medicine is a sufficient foundation — a fair one when considering that senior residents spend an enormous amount of time on “scutwork” and micromanagement, rather than garnering clinical acumen. In short, the ABIM puts the emphasis on the specialty rather than the core for MD/PhD residents, thereby maximizing their research momentum. When will the Royal College see fit to introduce such research pathways into our programs? The corollary: Are we now compromising research excellence for the sake of “clinical rigour”? The absence of such pathways possibly defeats, in my view, one of the laudable objectives of MD/PhD programs: producing world-class clinician scientists.

Dylan Pillai Intern, Internal Medicine Stanford University Medical Center Stanford, Calif.